Physical and psychological management and secondary prevention of self-harm in primary and secondary care2 standard 1: every patient must have a comprehensive assessment of risk and psychosocial needs standard 2: staff showed respect and understanding to every admitted patient who had self-harmed. Assessment of psychiatric history and future risk of self-harm is crucial in deciding management, just as a patient's cardiovascular or respiratory history needs to be taken into account when deciding on surgery. Self harm is one of the most common reasons for general hospital admission1 2 people who present to the emergency department with self harm have a relative risk of suicide 49 times greater than the general population,3 and up to 100 times greater in the next year.
Issn 2042-4779 clinicalauditscom 54 management of self-harming patients in a psychiatric ward abstract aims this audit compared the current management of self-harming patients, admitted to aston ward, lister hospital mental health unit, stevenage, with the national institute. Five patient accounts highlighted the significance of alcohol in their history of self-harm one patient was presently abstinent, while alcohol had been involved in the most recent self-harm of the other four for three patients self-harm was frequently the culmination of a binge drinking session which could last several days.
The assessment and management of self-harming patients in an accident and emergency department: an action research project alastairalastair m mcelroy ba, ma, dipned, rmn, rgn principal lecturer, university of luton, stoke mandeville hospital, aylesbury, bucks hp21 8al. Deliberate self-harm is a common problem that often requires orthopaedic treatment patients with injuries due to deliberate self-harm are often referred to our unit this study assessed the type of treatment required and the cost of treatment we undertook a retrospective survey of deliberate self. Self-injury may include cutting, hitting, burning, biting and ingestion of foreign objects although the method of self-harm is useful clinically, for example in considering risk management or discharge planning, it is not helpful to classify a patient solely by the method he/she presents with.
In parts of the country less than a quarter of self-harming patients (22%) attending a&e were assessed by specialist mental health professionals before leaving hospital, researchers at the university of manchester found. Furthermore, self-harm patients have reported dissatisfaction with the care provided by nurses and other health care staff the empirical literature on the management of self-harm patients in a & e highlights the value of problem-solving approaches to patient care (repper, 1999) the basic problem-solving model incorporates five principles, outlined in table 1.
Background self-harm is a common reason for hospital presentation however, evidence to guide clinical management of these patients to reduce their risk of repeat self-harm and suicide is lacking. This essay considers nursing issues in the management of a self-harm patient admitted to an emergency department unit of an nhs trust salient issues for the qualified nurse include ethical dilemmas, associated with conflicting codes of conduct, important management issues relating to assessment, diagnosis, psychological and medical treatment, in-patient care, and medical-legal considerations.
Self-harm is the biggest independent predictor of future suicide it is important that all patients receive a thorough psychosocial assessment at triage self-harm is a behaviour and not a diagnosis in itself it can be a symptom of an underlying difficulty, or serve a function for the person harming him-/herself. Crossref | pubmed | google scholar see all references cutting is the commonest method of self-injury, 1 x 1 hawton, k, rodham, k, evans, e et al deliberate self harm in adolescents: self report survey in schools in england bmj 2002 325: 1207–1211 crossref | pubmed | google scholar see all references usually of the wrist and forearm many patients are known to plastic surgery units due to repeated episodes of injury. Hospital management of self-harm patients and risk of repetition: systematic review and meta-analysis.